NPI | 1578180584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: WA PO61513723) |
Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: PA SC007106) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007106) | |
Enumeration Date | 2020-06-26 |
Last Update Date | 2024-10-01 |